Sexual function in women with complex PTSD: a comparative study

Posttraumatic stress disorder (PTSD) is associated with impaired sexual functioning in women, but the effects of complex PTSD (CPTSD) remain unclear. This study tested three hypotheses: (1) women with CPTSD would report lower overall sexual function than women with PTSD and trauma-exposed controls; (2) the pain domain would show the largest group differences; and (3) CPTSD symptom severity would be negatively associated with sexual function, while PTSD symptom severity would not.

A cross-sectional study included 386 Mexican female university students (18-55 years) who completed the Female Sexual Function Index (FSFI), International Trauma Questionnaire (ITQ), and Adverse Childhood Experiences Questionnaire (ACE-IQ). Group differences were assessed using ANOVA with post-hoc comparisons. Multivariable linear regressions examined whether CPTSD severity predicted sexual function independently of PTSD severity and age. A sensitivity analysis excluded women aged 45 and older.

FSFI total scores differed significantly across groups (F = 3.52, p = 0.031). Women with CPTSD reported lower overall sexual function (M = 26.56, SD = 6.41) than trauma-exposed controls (M = 28.86, SD = 5.03; p = 0.047). In the pain domain, women with CPTSD reported greater sexual pain than controls (F = 6.35, p = 0.002). Multivariable regressions showed that CPTSD severity predicted lower FSFI total scores (β = -0.22, p < 0.001), independent of age and PTSD severity (adjusted R² = 0.028). For sexual pain, the bivariate association with CPTSD (rho = -0.16, p < 0.01) did not persist after adjusting for age; age was the only significant predictor (β = 0.02, p = 0.007). Sensitivity analyses yielded unchanged results.

CPTSD severity is associated with poorer overall sexual function, independent of age and PTSD severity. However, the association with sexual pain did not persist after accounting for age. Clinical and research implications are discussed.